LoBue Stephen A, Mano Fukutaro, Schaefer Erin, LoBue Thomas D
LoBue Laser and Eye Medical Centers, Inc., Murrieta, California, USA.
Suita Tokushukai Hospital Eye Center, Suita, Japan.
Case Rep Ophthalmol. 2018 Aug 9;9(2):369-374. doi: 10.1159/000492106. eCollection 2018 May-Aug.
To report a case of a patient with unilateral Adie's pupil who underwent bilateral cataract extraction with multifocal and monofocal posterior chamber intraocular lens (IOL) implantation.
A 74-year-old woman presented to our institution complaining of worsening near vision. Gross examination revealed a 6-mm fixed pupil on the right eye (OD) and a 5-mm pupil reacting to 3 mm with light on the left eye (OS). Slit lamp examination revealed a tonic pupil with an exaggerated pupillary constriction to dilute pilocarpine OD. Dilated exam revealed 2-3+ nuclear and cortical lens changes bilaterally. The patient's active lifestyle, personality, and biometry measurements made her a good candidate for multifocal IOL (MfIOL) implantation OS. Femtosecond laser-assisted cataract extraction with a ReSTOR +3 ADD (SN60D1) implantation was performed OS. Monofocal lens implantation (SN60WF) was performed OD 6 months later.
One year postoperatively, our patient had an uncorrected visual acuity (VAsc) of 20/15 for distance and J10 for near OD. Her VAsc was 20/25 +1 for distance and J1 for near OS. Visual acuity when using both eyes was 20/15 for distance and J1 for near.
Optimizing success for MfIOL implantation is a multifactorial process. Large pupils preoperatively are of particular concern, as this may lead to increased dysphotopsia with pupil-dependent MfIOLs. Thus, patients with unilateral mydriasis, such as Aide's pupil, may have a beneficial outcome combining multifocal-monofocal implantation after bilateral cataract extraction, especially if they are not a candidate for monovision but desire spectacle independence.
报告一例单侧阿-罗瞳孔患者接受双眼白内障摘除并植入多焦点和单焦点后房型人工晶状体（IOL）的病例。
一名74岁女性因近视力恶化前来我院就诊。大体检查发现右眼（OD）瞳孔固定直径6mm，左眼（OS）瞳孔直径5mm，对光反应至3mm。裂隙灯检查发现右眼为强直性瞳孔，对稀释的毛果芸香碱瞳孔收缩反应过度。散瞳检查发现双眼均有2-3+核性和皮质性晶状体改变。患者积极的生活方式、性格及生物测量结果使其成为左眼植入多焦点IOL（MfIOL）的合适人选。左眼行飞秒激光辅助白内障摘除并植入ReSTOR +3 ADD（SN60D1）人工晶状体。6个月后右眼植入单焦点人工晶状体（SN60WF）。
术后1年，患者右眼远视力未矫正视力（VAsc）为20/15，近视力为J10。左眼远视力VAsc为20/25 +1，近视力为J1。双眼同时使用时，远视力为20/15，近视力为J1。
优化MfIOL植入的成功率是一个多因素过程。术前瞳孔大尤其值得关注，因为这可能导致依赖瞳孔的MfIOL的眩光增加。因此，单侧瞳孔散大的患者，如阿-罗瞳孔患者，在双眼白内障摘除后联合多焦点-单焦点植入可能会有较好的效果，特别是如果他们不适合单眼视但希望摆脱眼镜。
